ED Form 1189, 01/95

(Previous Editions Obsolete.)

OMB NO. 1840-0582
Expiration Date: 10/31/2000

U. S. Department of Education
Federal Family Education Loan Program
Guaranty Agency Monthly Claims and Collections Report
Cover Page
Guaranty Agency State Name: _________________
For Month of (MM-CCYR): ___-___
Guaranty Agency Code: _____
Page ____ of ____ Pages
Authority:

The collection of this information is authorized by the Higher Education Act of 1965,
as amended, Part B, Federal Family Education Loan Program(20 U.S.C. 1071 Et Seq.).

Reporting Burden:
According to the Paperwork Reduction Act of 1995, no persons are required to
respond to a collection of information unless such collection displays a valid,
OMB control number. The valid OMB control number for this information collection is 1840-0582. The
time required to complete this information collection is estimated to average 5 hours per response, including
the time to review instructions, search existing data resources, gather and maintain the data needed, and
complete and review the information collection. If you have any comments concerning the accuracy of the time
estimate(s) or suggestions for improving this form, please write to: U.S. Department of Education,
Washington, D.C. 20202-4651. If you have any comments or concerns regarding the status of your individual
submission of this form, write directly to: Guaranty Agency Reporting, U.S. Department of Education, P.O. Box
23457, L’Enfant Plaza Station, Washington, D.C. 20026.
Warning:

Any person who knowingly and willfully destroys or conceals any record relating to the
provision of assistance under Title IV of the Higher Education Act of 1965, as amended,
or attempts to so destroy or conceal with intent to defraud the United States or to
prevent the United States from enforcing any right obtained by subrogation under Part B of Title IV, shall
upon conviction thereof, be fined not more than $20,000 or imprisoned not more than 5 years, or both, under
the provisions of 20 U.S.C. 1097.
Instructions:

There are separate instructions for the completion of this form.
those instructions carefully before completing the form.

please read

Form Submission:
Submit the Monthly Claims and Collections Report via the U.S. Postal Service
to the address below. (Submission of this cover page is optional.)
U.S. Department of Education
Guaranty Agency Processing
P. O. Box 4137
Greenville, TX 75403-4137
ED Form 1189, 01/95
OMB NO. 1840-0582
(Previous Editions Obsolete.)
Expiration Date: 10/31/2000
Guaranty Agency Monthly Claims and Collections Report

Guaranty Agency State Name: _________________
Guaranty Agency Code: _____
Loan Type Code: ____

For Month Of (MM-CCYR):

___-___

Page ____ of ____ Pages

Part A - Reinsurance and Supplemental Preclaims Assistance Request
Number
Principal, Lender &
of
GA Claim Interest
--Claims---Paid to Lenders-(A)
(B)
Reinsurance Request Section:

Non-Reinsured
GA
--Interest--(C)

A-1

Defaults

#_________

$__________________

$__________________

A-2

Exempted Claims

#________

$__________________

$__________________

A-3

Bankruptcy (Chapter 12 & 13)#________

$__________________

$__________________

A-4

Death and Disability

#________

$__________________

$__________________

A-5

Bankruptcy (Chapter 7 & 11) #________

$__________________

$__________________

A-6

Closed Schools

#________

$__________________

$__________________

A-7

False Certification

#________

$__________________

$__________________

A-8

Lender Of Last Resort Loan

#________

$__________________

$__________________

Number of
--Accounts-(A)

Total Unpaid Principal
-and Accrued Interest(B)

#_________

$_____________________

Supplemental Preclaims Assistance Section:
A-9

Accounts With No Claim Filed
(SPA initiated On/After 10/1/93)

ED Form 1189, 01/95
(Previous Editions Obsolete.)

OMB NO. 1840-0582
Expiration Date: 10/31/2000

Guaranty Agency Monthly Claims and Collections Report
Guaranty Agency State Name: _________________
Guaranty Agency Code: _____
Loan Type Code: ____

For Month Of (MM-CCYR):

___-___

Page ____ of ____ Pages

Part B:

Additional Reinsurance Request and Lender Referral Fees
Number
of
--Claims-(A)

Additional
Principal, Lender &
GA Claim Interest
--Paid to Lenders-(B)

Additional Payment by Agency to Lender Section:
B-1

Defaults

#_________

$__________________

B-2

Exempted Claims

#_________

$__________________

B-3

Bankruptcy (Chapter 12 & 13)#_________

$__________________

B-4

Death and Disability

#_________

$__________________

B-5

Bankruptcy (Chapter 7 & 11) #_________

$__________________

B-6

Closed Schools

#_________

$__________________

B-7

False Certification

#_________

$__________________

B-8

Lender of Last Resort Loan

#_________

$__________________

ED Form 1189, 01/95
(Previous Editions Obsolete.)

OMB NO. 1840-0582
Expiration Date: 10/31/2000

Guaranty Agency Monthly Claims and Collections Report
Guaranty Agency State Name: _________________
Guaranty Agency Code: _____
Loan Type Code: ____
Part B:

For Month Of (MM-CCYR):

___-___

Page ____ Of ____ Pages

Additional Reinsurance Request and Lender Referral Fees (Continued)
Increase
--Increase in Amounts of Reinsurance Due--in Number
for
Claims
Principal, Lender &
---Paid---GA Claim Interest(A)
(B)
Understated Reinsurance Claims Section:

B-9

Defaults

#_________

$__________________

B-10

Exempted Claims

#_________

$__________________

B-11

Bankruptcy (Chapter 12 & 13)#_________

$__________________

B-12

Death and Disability

#_________

$__________________

B-13

Bankruptcy (Chapter 7 & 11) #_________

$__________________

B-14

Closed Schools

#_________

$__________________

B-15

False Certification

#_________

$__________________

B-16

Lender of Last Resort Loan

#_________

$__________________

Number of
---Loans--(A)

Principal Amount
----of Loans---(B)

#__________

$_________________

Lender Referral Fee Section:
B-17 Lender Referral Fee
ED Form 1189, 01/95
(Previous Editions Obsolete.)

OMB No. 1840-0582
Expiration Date: 10/31/2000

Guaranty Agency Monthly Claims And Collections Report
Guaranty Agency State Name: _________________
Guaranty Agency Code: _____
Loan Type Code: ____
Part C:

For Month Of (MM-CCYR):

Page ____ of ____ Pages

Change in Status Supplemental Reinsurance Request
----Account Balance at Conversion---of
Unpaid
Principal,
Interest
Purchased
Number
Additional
After Date of Interest &
of
Unpaid
Reinsurance
Pre-11/90
Accrued
Other
--Claims-- -Principal- ---Payment--- ----SPA----Interest-- --Charges-(A)
(B)
(C)
(D)
(E)
(F)

Original Reinsurance Paid for 98%, 90%, 88%, 80%, or 78% of Principal and Interest Section:
C-1

Death or Disability

___-___

#_________
C-2

$___________

$____________

$__________

$____________

$___________

$____________

$__________

$__________

$____________

$___________

$____________

$__________

$__________

$____________

$___________

$____________

$__________

$____________

$___________

$__________

Closed Schools
#_________

C-5

$____________

Bankruptcy (Chapter 7 & 11)
#_________

C-4

$__________

Bankruptcy (Chapter 12 & 13)
#_________

C-3

$__________

False Certification

#_________ $__________
ED Form 1189, 01/95
(Previous Editions Obsolete.)

$____________
OMB No. 1840-0582
Expiration Date: 10/31/2000

Guaranty Agency Monthly Claims and Collections Report
Guaranty Agency State Name: _________________
Guaranty Agency Code: _____
Loan Type Code: ____
Part D:

D-2
D-3
D-4

___-___

Page ____ of ____ Pages

Full Refund of Reinsurance Claims

Outstanding
Number
Principal Net
of
of any
--Claims-- --Complement-(A)
(B)
Reinsurance Claims Paid in Current Fiscal Year Section:
D-1

For Month Of (MM-CCYR):

Outstanding
Accrued Interest
-----Due ED----(C)

Outstanding
Non-Reinsured
-GA Interest(D)

Defaults
#_________

$_________________ $________________

$_____________

#_________

$_________________

XXX

$_____________

Bankruptcy (Chapter 12 & 13)
#_________

$_________________

XXX

$_____________

$_________________

XXX

$_____________

Exempted Claims

Death and Disability
#_________

D-5
D-6
D-7
D-8

Bankruptcy (Chapter 7 & 11)
#_________

$_________________

XXX

$_____________

#_________

$_________________

XXX

$_____________

#_________

$_________________

XXX

$_____________

#_________

$_________________ $________________

Closed Schools
False Certification
Lender of Last Resort Loan
$_____________

ED Form 1189, 01/95
(Previous Editions Obsolete.)

OMB No. 1840-0582
Expiration Date: 10/31/2000

Guaranty Agency Monthly Claims and Collections Report
Guaranty Agency State Name: _________________
Guaranty Agency Code: _____
Loan Type Code: ____
Part D:

D-10
D-11
D-12
D-13
D-14
D-15
D-16

___-___

Page ____ of ____ Pages

Full Refund of Reinsurance Claims

Outstanding
Number
Principal Net
of
of Any
--Claims-- --Complement-(A)
(B)
Reinsurance Claims Paid in Previous Fiscal Year Section:
D-9

For Month Of (MM-CCYR):

Outstanding
Accrued Interest
-----Due ED----(C)

Outstanding
Non-Reinsured
-GA Interest(D)

Defaults
#_________

$_________________ $________________

$_____________

#_________

$_________________

XXX

$_____________

Bankruptcy (Chapter 12 & 13)
#_________

$_________________

XXX

$_____________

#_________

$_________________

XXX

$_____________

#_________

$_________________

XXX

$_____________

#_________

$_________________

XXX

$_____________

#_________

$_________________

XXX

$_____________

#_________

$_________________ $________________

Exempted Claims

Death and Disability
Bankruptcy (Chapter 7 & 11)
Closed Schools
False Certification
Lender of Last Resort Loan
$_____________

ED Form 1189, 01/95
(Previous Editions Obsolete.)

OMB No. 0840-0582
Expiration Date: 10/31/2000

Guaranty Agency Monthly Claims and Collections Report
Guaranty Agency State Name: _________________
For Month Of (MM-CCYR): ___-___
Guaranty Agency Code: _____
Month Reinsurance Claim Paid by ED (MM-CCYR): ___-___
Loan Type Code: ____
Page ____ of ____ Pages
Part E:

Refunds for Overpayment and Overbilling
Number
of
--Claims-(A)

Refund
Net of Any
----Complement----(B)

Partial Refund of Reinsurance Claims Section:
E-1

Defaults

#_________

$__________________

E-2

Exempted Claims

#_________

$__________________

E-3

Bankruptcy (Chapter 12 & 13)#_________

$__________________

E-4

Death and Disability

#_________

$__________________

E-5

Bankruptcy (Chapter 7 & 11) #_________

$__________________

E-6

Closed Schools

#_________

$__________________

E-7

False Certification

#_________

$__________________

E-8

Lender of Last Resort Loan

#_________

$__________________

ED Form 1189, 01/95
(Previous Editions Obsolete.)

OMB No. 1840-0582
Expiration Date: 10/31/2000

Guaranty Agency Monthly Claims and Collections Report
Guaranty Agency State Name: _________________
For Month Of (MM-CCYR): ___-___
Guaranty Agency Code: _____
Month Reinsurance Claim Paid by ED (MM-CCYR): ___-___
Loan Type Code: ____
Page ____ of ____ Pages
Part E:

Refunds for Overpayment and Overbilling (Continued)
Decrease
in Number
Claims
---Paid--(A)

--Decrease in Amounts of Reinsurance Due--for
Principal, Lender &
-GA Claim Interest(B)

Overstated Reinsurance Claims Section:
E-9

Defaults

#_________

$__________________

E-10

Exempted Claims

#_________

$__________________

E-11

Bankruptcy (Chapter 12 & 13)#_________

$__________________

E-12

Death and Disability

#_________

$__________________

E-13

Bankruptcy (Chapter 7 & 11) #_________

$__________________

E-14

Closed Schools

#_________

$__________________

E-15

False Certification

#_________

$__________________

E-16

Lender of Last Resort Loan

#_________

$__________________

ED Form 1189, 01/95
OMB No. 1840-0582
(Previous Editions Obsolete.)
Expiration Date: 10/31/2000
Guaranty Agency Monthly Claims and Collections Report
Guaranty Agency State Name: _________________
Guaranty Agency Code: _____
Loan Type Code: ____

For Month Of (MM-CCYR): ___-___
Collections Received in Month Of (MM-CCYR): ___-___
Page ____ of ____ Pages

Part F:

Default and Bankruptcy Collections
Number
of
Total
-Accounts--Collected--(A)
(B)
Default Collection Section:
F-1

100%/98% Reinsurance Reimbursement
#___________

F-2

$____________________

$_________________

$_________________

$____________________

$_________________

$____________________

$_________________

$____________________

$_________________

80%/78% Reinsurance Reimbursement
#___________

F-4

$_________________

90%/88% Reinsurance Reimbursement
#___________

F-3

Applied to Principal,
Purchased Interest &
Applied to
--Pre 11/90 SPA--Accrued Interest(C)
(D)

$_________________

Lender of Last Resort Loan Collections
#___________

$_________________

Borrower Payment Returned - Status Change Default to Closed School/False Certification Section:
F-5

Closed Schools
#___________

F-6

$_________________

$____________________

$_________________

$_________________

$____________________

$_________________

False Certification
#___________

ED Form 1189, 01/95
(Previous Editions Obsolete.)

OMB No.1840-0582
Expiration Date: 10/31/2000

Guaranty Agency Monthly Claims and Collections Report
Guaranty Agency State Name: _________________
Guaranty Agency Code: _____
Loan Type Code: ____
Part F:

For Month Of (MM-CCYR): ___-___
Collections Received in Month Of (MM-CCYR): ___-___
Page ____ of ____ Pages

Default and Bankruptcy Collections
Number
of
-Accounts(A)

Total
--Collected--(B)

Applied to Principal,
Purchased Interest &
Applied to
--Pre 11-90 SPA--Accrued Interest(C)
(D)

Bankruptcy Recovery Section:
F-7

Chapter 12 & 13 Bankruptcies
#___________

F-8

$__________________

$___________________

$__________________

$__________________

$___________________

$__________________

Chapter 7 & 11 Bankruptcies
#___________

ED Form 1189, 01/95
(Previous Editions Obsolete.)

OMB No. 1840-0582
Expiration Date: 10/31/2000

Guaranty Agency Monthly Claims and Collections Report
Guaranty Agency State Name: _________________
Guaranty Agency Code: _____
Loan Type Code: ____
Part G:

G-1

G-2

Activity on Accounts: Federal Tax Refund Offset
Number
of
-Accounts(A)

Total
Collected/
---Activity--(B)

Applied to
Principal &
-Purchased Interest(C)

Applied to
-Accrued Interest(D)

#_________

$_____________

$___________________

$_________________

$_____________

$___________________

$_________________

$_____________

$___________________

$_________________

$_____________

$___________________

$_________________

IRS Offset

Non-Federal Share Offset
#_________

G-3

Overpayment Refunds
#_________

G-4

For Month Of (MM-CCYR): ___-___
Page ____ of ____ Pages

Injured Spouse Claims
#_________

ED Form 1189, 01/95
(Previous Editions Obsolete.)

OMB No. 1840-0582
Expiration Date: 10/31/2000

Guaranty Agency Monthly Claims and Collections Report
Guaranty Agency State Name: _________________
Guaranty Agency Code: _____
Loan Type Code: ____
Part H:

Rehabilitated Loans

--Number-(A)
H-1

For Month Of (MM-CCYR): ___-___
Loans Rehabilitated in Month Of (MM-CCYR): ___-___
Page ____ of ____ Pages

Outstanding
Principal &
Purchased
---Interest--(B)

Outstanding
Accrued
--Interest-(C)

Outstanding
Pre-11/90
----SPA---(D)

Outstanding
Other
--Charges-(E)

100%/98% Reinsurance Reimbursement
#___________ $_______________ $____________ $____________ $___________

H-2

90%/88% Reinsurance Reimbursement
#___________ $_______________ $____________ $____________ $___________

H-3

80%/78% Reinsurance Reimbursement
#___________ $_______________ $____________ $____________ $___________

H-4

Rehabilitated Lender of Last Resort Loan
#___________ $_______________ $____________ $____________ $___________

ED Form 1189, 01/95
(Previous Editions Obsolete.)

OMB No. 1840-0582
Expiration Date: 10/31/2000

Guaranty Agency Monthly Claims and Collections Report
Guaranty Agency State Name: _________________
Guaranty Agency Code: _____
Loan Type Code: ____
Part I:

For Month Of (MM-CCYR):

___-___

Page ____ of ____ Pages

Non-Payment Activity
(This Part Must Always Be
Submitted For All Loan Types)

Number
of
--Claims-(A)

----Account Balance at Conversion---of
Principal,
Purchased
Interest &
Pre-11/90
Accrued
Other
----SPA---- -Interest-- --Charges-(B)
(C)
(D)

Change of Status for Default and Lender-of-Last-Resort Loan Claims Paid at 100% Section:
I-1

Bankruptcy (Chapter 12 & 13)

#_________

$__________

$__________

$__________

I-2

Death and Disability

#_________

$__________

$__________

$__________

I-3

Bankruptcy (Chapter 7 & 11)

#_________

$__________

$__________

$__________

I-4

Closed Schools

#_________

$__________

$__________

$__________

I-5

False Certification

#_________

$__________

$__________

$__________

Change of Status Bankruptcy (Chapter 12 and 13) Not Discharged:
I-6

Defaults

#_________

$__________

$___________

$_________

I-7
Lender of Last Resort Loan
#_________ $__________ $___________ $_________
ED Form 1189, 01/95
OMB No. 1840-0582
(Previous Editions Obsolete.)
Expiration Date: 10/31/2000
Guaranty Agency Monthly Claims and Collections Report
Guaranty Agency State Name: _________________
Guaranty Agency Code: _____

For Month Of (MM-CCYR):
Collections Received in Month Of (MM-CCYR):

___-___
___-___

Loan Type Code:

____

Page ____ of ____ Pages

Part J:

GA Administrative Wage Garnishment Collections
Number
Applied to Principal,
of
Total
Purchased Interest &
Applied to
-Accounts--Collected----Pre 11/90 SPA--Accrued Interest(A)
(B)
(C)
(D)
Default Collection Section:
J-1

100%/98% Reinsurance Reimbursement
#___________

J-2

$__________________ $_____________________

$_________________

80%/78% Reinsurance Reimbursement
#___________

J-4

$_________________

90%/88% Reinsurance Reimbursement
#___________

J-3

$__________________ $_____________________

$__________________ $_____________________

$_________________

Lender of Last Resort Loan Collections
#___________

$__________________ $_____________________

$_________________

Borrower Payment Returned - Status Change Default to Closed School/False Certification Section:
J-5

Closed Schools
#___________

J-6

$__________________ $_____________________

$__________________

False Certification

#___________
ED Form 1189, 01/95
(Previous Editions Obsolete.)

$__________________ $_____________________

$__________________
OMB No. 1840-0582
Expiration Date: 10/31/2000

Guaranty Agency Monthly Claims and Collections Report
Guaranty Agency State Name: _________________
Guaranty Agency Code: _____
Part K:
K-1

For Month Of (MM-CCYR): ___-___
Page ____ of ____ Pages

Certification
(This Part Must Always Be Submitted.)

Type of Submission (Check Only One):

Original:

_______

Correction:

________

K-2

No Offset Options
(Complete one if agency does not want ED to automatically offset amounts owed to ED.)
A.

Transaction Type (Check Only One):

Check:

B.

Amount:

Date Mailed/EFT Completed (MM-DD-CCYR):

$______________________

K-3

Name of Guaranty Agency:

K-4

Typed Name of Contact Person:

K-5

Contact Telephone Number:

_____

Electronic Funds Transfer:

_____

___-___-___

____________________________________________________________________
_______________________________________________________________

(_____)________________

Certification Statement:
The data submitted for this Guaranty Agency Monthly Claims and Collections Report
(ED Form 1189) is correct to the best of my knowledge and belief. I certify that it conforms to the laws,
regulations and policies applicable to the Federal Family Education Loan Program. I certify under threat of
penalty (including loss of reinsurance) that diligent attempts have been made to locate borrowers through
reasonable skip tracing techniques for which default claims are filed herein. I agree that all documents,
files and accounts supporting this data shall be subject to audit by the Secretary of Education or other
authorized representatives of the United States Government.
K-6

Signature of Authorized Official:

K-8

Typed Name of Authorized Official:

K-9

Title of Authorized Official:

________________________________

K-7

Date:

_________

__________________________________________________________

_______________________________________________________________